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Office of Graduate Medical Education Program Directors Presentation Grievances & Troubled Residents. By: Janet J. Harszlak, Ph.D. GME Grievance Administrative Consultant By: Lawrence M. Ross Hurwitz & Fine, P.C. (Attorney for University Medical Resident Services, PC) - PowerPoint PPT Presentation
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Hurwitz & Fine, P.C.
Office of Graduate Medical Education
Program Directors Presentation
Grievances & Troubled ResidentsBy: Janet J. Harszlak, Ph.D.
GME Grievance Administrative Consultant
By: Lawrence M. RossHurwitz & Fine, P.C.
(Attorney for University Medical Resident Services, PC)
March 11, 2008
Hurwitz & Fine, P.C.
March 11, 2008
“PLEASE BE ADVISED THAT YOUR RESIDENT INTENDS
TO FILE A GRIEVANCE WITH RESPECT
TO THE RECENT ACTIONTAKEN BY YOU.”
Hurwitz & Fine, P.C.
What Should You Do? Contact Office of Graduate Medical
Education
Hurwitz & Fine, P.C.
What Is Our Role?
Hurwitz & Fine, P.C.
The Importance of Early Intervention
Discuss grievance procedure policy
Case review* Evaluate strengths and
weaknesses of grievance* Prior meeting(s) with Resident? Level I discussion
Document Review* Complete?* Supportive of sanction?
Preparation for grievance hearing
Consultation with legal counsel
Hurwitz & Fine, P.C.
Why isn’t the Professional Judgment of the Program Director Respected More Often by the Grievance
Committee? Insufficient notice of disciplinary
action Non-compliance with UB policies Non-compliance with “internal”
(program) policies or criteria Sanction is disproportionate Documentation does not support
sanction Inadequate or incomplete
documentation
Hurwitz & Fine, P.C.
Recurrent Theme?
Imprecise or ambiguous terms of probation or suspension
Hurwitz & Fine, P.C.
Recommendation for Change
Written notice Commencement date Stated period (extension) Well conceived remediation program
* Specific objectives* Recommended activities* Counseling or intervention* Performance measures* Periodic evaluation
Timely notice to supervising faculty Communicate consequences of failure
Hurwitz & Fine, P.C.
Root Cause of Disciplinary Action?
May predate event that precipitated the disciplinary action!
Did you have prior notice of problem?
Warning signs
Hurwitz & Fine, P.C.
Troubled Residents
Sample Definition – Residents with problems who do not progress (respond well to remediation or discipline) or who engage in one or more acts of misconduct
Hurwitz & Fine, P.C.
Troubled Residents (con’t)
Disproportionate Source of Disciplinary Actions
Disproportionate Source for Litigation
Hurwitz & Fine, P.C.
If we could go back in time, what could have been done differently?
Hurwitz & Fine, P.C.
Self Help Measures
Hurwitz & Fine, P.C.
ERAS Common Application Form
Hurwitz & Fine, P.C.
ERAS Common Application Form
Review for Completeness
Review for Accuracy
Includes Continuing Representations
Hurwitz & Fine, P.C.
Completeness
Hurwitz & Fine, P.C.
Completeness
Is all residency training program experience disclosed?
Any gaps in work or educational history?
Hurwitz & Fine, P.C.
Accuracy
Hurwitz & Fine, P.C.
Accuracy - - Odd Explanations
“I missed the deadline for the 2007 match. Therefore, I have to sit out a year while I apply now for the 2008 match!”
“I resigned from this program due to personal reasons and returned home to care for an infirm parent.”
“I became unhappy with the program and withdrew in June, 2007.”
Hurwitz & Fine, P.C.
ERAS Application Representations are
CONTINUING Representations
Must disclose material changes in representations
Must disclose subsequent events
Hurwitz & Fine, P.C.
Recommendation: Contact References
Hurwitz & Fine, P.C.
Recommendation: Explore Red Flags
“Our policy limits me to confirm dates of residency and education credit.”
“I am prohibited from talking about any corrective action taken with regard to this resident.”
“The matter is currently in litigation.”
Hurwitz & Fine, P.C.
Recommendation: Conduct a Personal Interview
Observe personal demeanor
Confirm language skills
Determine VISA status
If telephone interview, confirm identity
Hurwitz & Fine, P.C.
Recommendation: Do not execute and deliver Residency Employment Agreement prior to receipt and review of application
Hurwitz & Fine, P.C.
Recommendation: Require acceptance within 30 days of offer. Be wary of delays
Hurwitz & Fine, P.C.
Does Everyone Deserves a Second Chance
Question:
When does duty to society and profession outweigh natural empathy for Resident’s chosen career path?
Hurwitz & Fine, P.C.
Troubled Residents: Rush to Judgment
Bypass Remediation for Probation
Hurwitz & Fine, P.C.
Factors?
Various incidents over time (crescendo) Declining resident morale Increasing faculty dissatisfaction Third party complaints
Hurwitz & Fine, P.C.
Troubled Residents: Assessment and Evaluation
Unwanted Delay in Taking Action
Hurwitz & Fine, P.C.
Factors
Inexperienced faculty supervision Difficult Resident Avoid institutional processes (grievance
hearing) Poor Internal Controls: Unaware of
failure to progress Preference to Handle Informally Ignore Warning Signs
Hurwitz & Fine, P.C.
Consequences of Unwarranted Delay
Hurwitz & Fine, P.C.
Consequences of Unwarranted Delay
Non compliance with duty to assess and evaluate skills
Avoids responsibility to remediate Provokes resident’s ire Impact on program On program director (frustration) On residents (morale) On patients (quality of care; risk of harm)
Hurwitz & Fine, P.C.
Troubled Residents: Rush to Judgment
Inadequate or No Documentation
Hurwitz & Fine, P.C.
Troubled Residents: Rush to Judgment (con’t)
Documentation does not support identified deficiencies
* Inconsistent evaluations
* Action may raise questions about program integrity
* Unlawful discrimination
* Concerns about ACGME complaint
Hurwitz & Fine, P.C.
Troubled Residents: Rush to Judgment (con’t)
Disproportionate Penalty
* Materiality
* Frequency of problem
* Close in time to incident?
* Notice?
Hurwitz & Fine, P.C.
Troubled Residents: Rush to Judgment
Compliance with Policies
Hurwitz & Fine, P.C.
Troubled Residents: Compliance with Policies (con’t)
The importance of compliance
* Due process (Grievance Procedures)
Notice Opportunity to be heard
Hurwitz & Fine, P.C.
Troubled Residents: Compliance with Policies
The importance of compliance (con’t).
* ACGME standards for accreditation Professional judgment respected Departure from accepted
academic norms.* Key Policies
Evaluation Promotion Harassment Non-renewal Termination
Hurwitz & Fine, P.C.
Troubled Residents: Compliance with Policies (con’t)
Balance between academic or educational goals and employment law principles
Hurwitz & Fine, P.C.
“The End”